Care management in community care reform

Care management argument is about how to match services and other resources to the varying needs of individuals in a way which best fits the context. A focus on arrangements for the performance of core care management tasks has been one of the most important ways inwhich countries have attempted to achieve the matching of resources to individual needs in comunity care. The concept was first recognised and experimental projects started in Canada, England and the USA during the mid 1970s. Since then, care management has become a cornerstone of policy not only in the USA and the UK, but in many countries. Its importance and potential was recognised by the OECD in its study, Care of the Frail Elderly, a book of that name published in 1994. National and local service systems, the needs of subgroups of users, and the precise importance put on competing policygoals influence what care management arrangements are likely to improve equity, effectiveness and efficiency the most. The paper will draw on Professor Davies' experiments and other evaluative research in the UK, and on his analysis of the experience in other countries. He will discuss: what core care management tasks are recognised in care management argument, how they are related to aspects ofequity and efficiency, and the focus of care management argument on responsibility, authority and accountability for theirperformance;the evidence about the potential of care management for improving equity and efficiency; how care management arrangements are matched to policies, the circumstances of subgroups of users, and localservice, population, and area contexts; what the policy experience of field service agencies in the LTK and other countries teach about how to develop caremanagement in practice.